Virtual Obstacle-Based Gait Retraining Protocol for Neurogenic Fall Risk in the Elderly: A Comprehensive Review

Falls constitute one of the most significant health challenges among the elderly population, particularly in individuals with neurogenic impairments such as Parkinson's disease, stroke, diabetic peripheral neuropathy, and mild cognitive impairment.Neurogenic fall risk arises from complex interactions between motor deficits, sensory dysfunction, and cognitive decline, which are inadequately addressed by conventional fall-prevention interventions.In recent years, virtual obstacle-based gait retraining has emerged as an innovative rehabilitation strategy that integrates motor training with cognitive and perceptual challenges through virtual reality (VR) and augmented reality (AR) environments.This review critically examines the theoretical foundations, technological frameworks, clinical evidence, and practical implementation of virtual obstacle-based gait retraining protocols for reducing neurogenic fall risk in elderly individuals.Evidence from randomized controlled trials, systematic reviews, and feasibility studies suggests that virtual obstacle training improves gait adaptability, balance, executive function, and real-world fall outcomes when compared to traditional gait training alone.However, heterogeneity in intervention design, limited long-term follow-up data, and challenges related to accessibility and cost remain barriers to widespread adoption.This review synthesizes current evidence, identifies research gaps, and provides recommendations for clinical integration and future investigation.